Creating deformity where there is none: the sudden rise of the ‘explant’ surgeon

As we wait for our regulator, the Therapeutic Goods Administration, to deliberate before making its final decision on whether to suspend a variety of textured breast implants linked to cancer in Australia, news of the now worldwide recall of a particular type of Allergan implant linked to cancer has broken. The recall was prompted by the US regulator announcing a sudden increase in deaths from what was once thought to be a “rare” form of Lymphoma related to breast implants.

I do feel for the regulators trying to protect the public. They are often held to account for failure in cases where the blame lies first with commercial forces and greed. Undertrained or untrained doctors get their hands on an implant and then place them badly into a poorly informed, impressionable and vulnerable patient, primarily for the purposes of making a profit. This is not a failure of the device or even a failure of regulation, it is a failure of ethics, standards and professionalism.

And even as the ink is yet to hit the paper on the lastest regulatory action, we are witnessing another example of profit before professional ethics: the sudden rise of the “explant” surgeon. These professionals build business and marketing plans designed to target women who are now understandably anxious from reading the bad news about implants.

One of the most recently minted websites lists that the low-cost breast explant option (which is unsurprisingly the same price for low-cost breast augmentation) is for women who have no local complications at all, i.e. a normal breast and a normal implant.

Let me be clear. No one advocates preventative removal of an implant that does not have a problem. All this will do is create deformity where there is none and subject a healthy, but frightened, woman to the not inconsiderable risk of unnecessary surgery.  And this surgery can be major because often surgeons recommend not just removing the implant but all the tissue surrounding the implant. It can be a very destructive operation, particularly if the implant is placed under muscle.

But in a way I am not surprised – the same doctors that made money from implants going in can now make money from implants going out. I guess this instantly doubles their market opportunity!

So where will it all end? Where we have landed with crisis, anxiety, unnecessary and potentially dangerous surgery is the result of not truly tackling the root cause – which is to ensure that we dial down the sales and marketing and become more focused on being good doctors by putting the patient’s interests first.

Professor Deva is an Australian clinician and academic. He is the founder and director of the Integrated Specialist Healthcare Education and Research Foundation and head of plastic and reconstructive surgery at Macquarie University.

Source: The Sydney Morning Herald

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